Congratulations to Beth Winokur, PhD, RN, CEN, Jeannine Loucks, MSN, RN-BC, PMH and Glenn H. Raup, PhD, RN, MSN, MBA, CEN for their newly published article on caring for behavioral health patients at St. Joseph Hospital. SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details.
J Emerg Nurs.
2018; 44 26-32
USE OF A STANDARDIZED PROCEDURE TO IMPROVE BEHAVIORAL HEALTH PATIENTS CARE: A QUALITY IMPROVEMENT INITIATIVE.
Winokur EJ, Loucks J, Raup GH.
Abstract
PROBLEM: Meeting the complex needs of behavioral health (BH) patients in the emergency department is an ongoing challenge. Delays in care can have adverse consequences for patient and staff safety and delay transfer to specialized care.
METHODS: A quality improvement, nurse-driven initiative using a standardized procedure (STP) was developed and implemented in our busy Southern California Emergency Department, which focused on improving time to first medication and reduction of restraints. The project used a multidisciplinary team to develop the STP scoring tool and corresponding medications. Improvement was seen in all quality metrics. Time to first medication decreased from 43 minutes to less than 5 minutes. Adopting the STP resulted in a 50% decrease in use of restraints and time in restraints. Staff injuries remained low, with less than 3.6% of staff sustaining physical injuries.
DISCUSSION: The STP is an effective method to initiate immediate treatment of patients with signs of anxiety and aggression and thus reduce risk of violence. Additional benefits are reduced time to disposition and earlier initiation of specialized BH care. This process can be replicated in other emergency departments with similar clinical environments through the use of STPs or protocols based on state regulations. Contribution to Emergency Nursing Practice.

Congratulations to Deidra Bonner, MSN, RN and Beth Winokur, PhD, RN, CEN, on their newly published article on keratoconus. SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details.The eyes have it: A review of keratoconus, the nurse practitioner perspective.Bonner, D. & Winokur, E.J.The Journal for Nurse Practitioners2017; 13(8) 532-7
AbstractKeratoconus, a chronic, progressive ocular disease, is characterized by thinning and protrusion of the cornea. Etiology is not wholly understood; however, associations with heredity and environmental factors have been established. Keratoconic patients present with irregular astigmatism, diminishing visual acuity, and a continuous need to have prescriptive changes to spectacles and contact lenses. Keratoconus is a principal indicator for corneal transplantation. It affects both sexes and all races, beginning in adolescence. Nurse practitioners are uniquely positioned to interrupt the preventable contributors to keratoconus through assessment, prompt referral, and treatment of the physiologic and environmental factors linked to development and advancement.

Congratulations to Beth Winokur, PhD, RN, CEN, Jeannine Loucks, MSN, RN-BC, PMH and Dana Rutledge, PhD, RN for their newly published article on psychiatric education for nurses at St. Joseph Hospital. SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details.
EFFECT OF CONCENTRATED PSYCHIATRIC EDUCATION ON PERCEIVED COMPETENCE TO CARE FOR BEHAVIORAL HEALTH PATIENTS.Winokur EJ, Loucks J, Rutledge DN
Abstract Increasing numbers of behavioral patients are presenting to emergency departments, where competency of staff to care for this group is unknown. METHODS: This pre-post study measured the effects of a 7-hour conference on perceived competency of nurses and allied health professionals to care for behavioral health (BH) patients, as measured by the 23-item Behavioral Health Care Competency (BHCC) survey. RESULTS: Of 102 participants, most were emergency nurses (72%), acute care nurses and case managers (20%), and allied health personnel (trauma technicians and paramedics) (8%). Before the conference, participants had moderate average perceived competency in caring for BH patients. BHCC scores differed significantly by job category, with emergency nurses scoring higher than did nonemergency nurses and allied health personnel. Overall competence of participants increased significantly after the conference. The effect size, as reflected by partial eta squared, was 0.265. Significant increases in scores from before to after the conference occurred for the total BHCC and 2 competencies: practice/intervention and resource adequacy. DISCUSSION: This study provides needed research demonstrating improved perceived competency of nurses and allied health professionals to care for BH patients in emergency departments after brief concentrated education. Improvements occurred despite the fact that participants had initial baseline competencies that were higher than those of general hospital nurses from a historical sample.

Congratulations to Vivian Norman, MSN, RN, CCRN-K, Kim Rossillo, BSN, RN, PCCN and Katie Skelton, MBA, RN, NEA-BC for their newly published article on creating a healing environment at St. Joseph Hospital. SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details.CREATING HEALING ENVIRONMENTS THROUGH THE THEORY OF CARINGNovember 2016; 104(5) 401–409
Abstract: We describe the journey of personnel at one hospital to create a healing environment for patients and staff members at all levels through the implementation of Watson’s Theory of Human Caring and her Caritas Processes (ie, loving kindness, authentic presence, spirituality, being the environment, believing in miracles). We used experiential teaching and learning to explore the nursing theory with staff members. Positive outcomes include using Caritas Processes care plans in our electronic medical record, greater ease in the understanding and application of Watson’s theory, integrating a blessing for nurses during National Nurses Week, inclusion of ministry formation courses to extend the mission of the hospital’s founding religious order to current and future employees, and positive patient feedback. As a result of theory application, our nurses are more open to discussing caring, authentic presence and, when appropriate, prayer in their clinical narratives and how it is affecting patients and themselves.

Congratulations to Beth Winokur, PhD, RN, CEN, Dana Rutledge, PhD, RN and Amy Hayes, MSN, RN for their newly published article on factors that motivate or impede nurses employed by a Magnet® organization to pursue a baccalaureate education. SJO employees have access to the full article through Burlew Medical Library. Contact library staff for more details. MAGNET® FACILITY NURSES: PURSUING A BACCALAUREATE DEGREE IN NURSINGELIZABETH J. WINOKUR, PHD, RN, CEN, DANA N. RUTLEDGE, PHD, RN, AND AMY HAYES, MSN, RN Abstract: The aim is to explore factors that motivate and obstacles that impede nurses from pursuing baccalaureate education when employed by a Magnet® organization. In the Future of Nursing (2011), the Institute of Medicine concluded that the baccalaureate should be the minimum education for nurses. Magnet organizations are encouraged to meet the Institute of Medicine goal of 80% of nurses with a baccalaureate by 2020. In February 2014, a 15-item on-line survey was sent to nurses at a western Magnet-designated hospital to assess factors that motivate registered nurses to achieve a baccalaureate. Descriptive statistics and a general thematic analysis were completed. A 20% response rate (N = 191) was achieved. Most respondents (78%) entered nursing as associate degree/diploma graduates, and most (84%) either had a baccalaureate or masters degree or were currently enrolled in school. Encouragement from other nurses was the factor most frequently selected as facilitating return to school. Impeding factors included age and family responsibilities. A minority of nurses reported that they did not believe that a baccalaureate would make them a better nurse. Findings suggest that peer and leadership support play a larger role in facilitating baccalaureate completion more than previously reported. Additional research is needed to explore the role of registered nurse to registered nurse encouragement in facilitating educational advancement. (Index words: Magnet; Baccalaureate education; Nursing education; Motivation; Education, post RN; School re-entry) J Prof Nurs 0:1–9, 2016.

Question: I’ve heard that inductions increase the cesarean section (C/S) rate. An article from AWHONN email this week reports research showing that inductions decrease the C/S rate. Which is true? And how can we decrease our C/S rate?
Answer: A review of the literature proves to be quite controversial. There were no randomized control trials found in the literature most likely due to the fact that pregnant women are a vulnerable population because of the risks to mother/infant. The majority of studies are retrospective and findings conflict. Two studies, one a systematic review and a large retrospective study found a decrease in C-section(C/S) rate when induction was used compared to usual care (spontaneous labor, induced at a later time, etc.)(Caughey et al., 2009; Wilson et al.,2010). Other studies (Ehrenthal, Jiang & Strobino 2010; Glantz, 2010) discussed that problems exist in how researchers define the study population. These authors highlight that multiple factors, including increasing gestational age, alter the results mentioned above. Therefore after including these additional variables, they report that induction increases the C/S rate. Two other articles (Klein 2010; Nicholson et al. 2009) mention the AMOR-IPAT scoring system. AMOR–IPAT stands for Active Management of Risk in Pregnancy at Term- Upper limit of Optimal Delivery. In their studies utilizing this scoring system (algorithm) assists with finding the ideal gestation for each woman and determines her best delivery date. This scoring system in two studies states that when this scoring system is utilized for induction it reduces the C-Section rate. Final answer is the evidence is conflicting and there are many factors that influence the C-section rate. Maternal obesity for instance was not taken into consideration. Awareness and informed consent is imperative when deciding whether or not to induce. Ultimately this is something that should not be taken lightly and should be discussed thoroughly by the patient and her provider.
References: Akinsipe, C. D., Villalobos, L. E., & Ridley, R. T. (2012). A systematic review of implementing an elective labor induction policy. Journal of Obstetrics and Gynecology and Neonatal Nursing, 41(1) 5-16. doi:10.1111/j.1552-6909.2011.01320.x Caughey, A. B., Sundaram, V., Kaimal, A. J. Gienger, A., Cheng, Y. W., McDonald, K. M., . . .Bravata, D. M. (2009) Systematic review: Elective induction of labor versus expectant management of pregnancy. Annals of Internal Medicine, 151(4) 252-263. Ehrenthal, D. B., Jiang, X., & Strobino, D. M., (2010) Labor induction and the risk of cesarean delivery among nulliparous women at term. Obstetrics & Gynecology, 116(1) 35-42. Glantz, J. G. (2010) Term labor induction compared with expectant management. Obstetrics & Gynecology, 115(1). Nicholson, J. M., Cronholm, P., Kellar, L. C., Stenson, M. H., & Macones, G. A. (2009). The association between increased use of labor induction and reduced rate of cesarean delivery. Journal of Women’s Health, 18(11) 1747-1758. Wilson, B. L., Effken, J., & Butler, R. J. (2010) The relationship between cesarean section and labor induction. Journal of Nursing Scholarship, 42(2) 130-138. doi:10.1111/j.1547-5069.2010.01346.x

The purpose of this study was to describe patient-reported pre-, intra-, and postprocedure pain and anxiety levels for adults undergoing less invasive interventional radiology procedures. Most of the 53 outpatients were males, English speakers (91%), aged between 40 and 70 years, and having a chest port or arm port insertion procedure. Pain levels greater than 4 (0-10 scale) were experienced by a minority of participants (before, n = 1; during, n = 7; and after, n = 3). Many patients undergoing arm port and chest port insertions (22-68%) experienced some level of preprocedural anxiety. This is the first study to document the presence of pain and anxiety levels of outpatients receiving dialysis arteriovenous graft fistulogram or declotting procedures, chest port or arm port insertions, or tunneled dialysis catheter placements. Radiology nurses need to be aware of the pain and anxiety experiences of these patients and should be assessing and managing these in collaboration with their medical colleagues.

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice. Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care. Here is another in our series entitled "Clinical Inquiry". Q: What laboring positions are most effective in turning a posterior baby anterior? We currently use far left or lateral, upper LE on over bed table, and "frog" position. I have also seen hands on knees used.A: What does the evidence say?There are many beliefs regarding the best way to position a laboring woman to turn an OP baby to the occiput anterior (OA) position. A review of the literature notes conflicting evidence for the hands and knees position (Kariminia et al., 2004) (Stremler et al., 2005). There is not enough evidence at this time to confirm if all other positions (left lateral, right lateral or frog position) assist with rotating the baby from OP to OA position (Simkin, 2010). The evidence does show that the hands and knees position reduces back pain during labor (Hunter et al., 2007). None of the aforementioned positions have been shown to be harmful. At this time, the evidence in conflicting or there is not enough evidence to say one position is better than another to rotate an OP baby.References

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice. Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care. Here is the first of our series entitled "Clinical Inquiry".

Question: Why does St. Joseph RTs and RNs still lavage ET tubes with normal saline when evidence-based practice research shows this is not helpful and potentially harmful?

Answer:According to Lippincott’s Nursing Procedures, the use of normal saline is not included in the guidelines for suctioning. Current research is not clear. A recent study indicates that not using normal saline before endotracheal suction decreases the incidence of ventilator-associated pneumonia and associated medical costs (Mei-Yu, Shu-Hua, & Yi-Hui, 2012). This is contradicted by findings from another recent study which found that instillation of normal saline decreased incidence of pneumonia in intubated and ventilated patients (Caruso, Denari, Ruiz, Demarzo, & Deheinzelin, 2009). One possible explanation for the discrepancy in results is from variations in the administration of the normal saline, time to suctioning, patient position, and dosages of saline.

Here are my picks from the nursing literature for February. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.

WHAT ARE THE FACTORS OF ORGANISATIONAL CULTURE IN HEALTH CARE SETTINGS THAT ACT AS BARRIERS TO THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE? A SCOPING REVIEW.

Williams, Brett; Perillo, Samuel; Brown, Ted;

Nurse Education Today, 2015 Feb; 35 (2): e34-41.

Abstract: Summary Background The responsibility to implement evidence-based practice (EBP) in a health care workplace does not fall solely on the individual health care professional. Organisational barriers relate to the workplace setting, administrational support, infrastructure, and facilities available for the retrieval, critique, summation, utilisation, and integration of research findings in health care practices and settings. Objective Using a scoping review approach, the organisational barriers to the implementation of EBP in health care settings were sought. Method This scoping review used the first five of the six stage methodology developed by Levac et al. (2010). The five stages used are: 1) Identify the research question; 2) identify relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. The following databases were searched from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google Scholar, The Cochrane Library and CINAHL. Results Of the 49 articles included in this study, there were 29 cross-sectional surveys, six descriptions of specific interventions, seven literature reviews, four narrative reviews, nine qualitative studies, one ethnographic study and one systematic review. The articles were analysed and five broad organisational barriers were identified. Conclusions This scoping review sought to map the breadth of information available on the organisational barriers to the use of EBP in health care settings. Even for a health care professional who is motivated and competent in the use of EBP; all of these barriers will impact on their ability to increase and maintain their use of EBP in the workplace.

BACK TO BASICS: IMPLEMENTING EVIDENCE-BASED PRACTICE.

Spruce, Lisa;

AORN Journal, 2015; 101 (1): 106-12.

Abstract: As health care transitions from volume-based care to value-based care, it is imperative that perioperative nurses implement evidence-based practices that support effective care. Implementing evidence-based practice is a challenge but improves patient outcomes, standardizes care, and decreases patient care costs. Understanding how care interventions work and how to implement them is important to compete in todays health care market. This "Back to Basics" article discusses how to identify, review, and appraise research; make recommendations to implement new practices; evaluate the outcomes of the implementations; and make necessary changes to facilitate evidence-based practice.

DEVELOPMENT OF EVIDENCE-BASED REMOTE TELEMETRY POLICY GUIDELINES FOR A MULTIFACILITY HOSPITAL SYSTEM.

Abstract: Over 10 years ago, the standards for cardiac monitoring were set forth by the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young. The standards were endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. The American Heart Association printed the standards as an American Heart Association Scientific Statement. The standards provided direction related to remote telemetry monitoring to acute care hospitals. Since the standards were published, remote monitoring of cardiac patients has increased dramatically prompting research and literature related to appropriate utilization. Appropriate and safe telemetry monitoring requires clearly written evidence-based facility policies. This article describes the process whereby a team of Veterans Hospital Administration nurses from across the country reviewed 70 remote telemetry policies representing 75 Veterans Hospital Administration hospitals for clarity, consistency, and congruency to existing levels of evidence found in the literature. This article describes the processes, successes, and challenges of compiling an evidence-based remote telemetry policy guideline.

Abstract: Infants born between 34 weeks 0 days to 36 weeks 6 days gestation have been identified as late preterm infants (LPIs) and account for 70% of preterm births and 9% of all births. The rise in elective deliveries in the past decade is believed to have contributed to the number of late preterm births. An interprofessional team including labor and delivery, neonatal intensive care, and postpartum care providers collaborated to address this issue at an urban academic medical center.

Abstract: Background: This literature review on nursing journal clubs evaluates the efficacy of the teaching strategy within the clinical setting. Method: Peer-reviewed articles were retrieved using an online journal database. Inclusion criteria incorporated information on efficacy of the teaching strategy, evidence-based practices, and continuing education as they related to nursing journal club initiatives. Results: The literature cited numerous benefits and proved to be in favor of nursing journal clubs. The most common benefits found were nurses remaining abreast of current research, skill development in reading and critically appraising research, and incorporation of evidence-based practices to patient care. Due to the self-motivated and voluntary nature of this teaching strategy, a limitation commonly identified was lack of participation, and further research on this limitation often was suggested. Conclusion: Nursing journal clubs proved to be an effective teaching strategy, a finding that remains consistent with the medical pioneers of the movement. J Contin Educ Nurs. 2014;45(12):559-565.

Abstract: While preparing medications in complex health care environments, nurses are frequently distracted or interrupted, which can lead to medication errors that may adversely affect patient outcomes. This pilot quality improvement project, which took place in a 32-bed surgical progressive care unit in an academic medical center, implemented five medication safety interventions designed to decrease distractions and interruptions during medication preparation: nursing staff education, use o f a medication safety vest, delineation of a no-interruption zone, signage, and a card instructing nurses how to respond to interruptions. Four types of distractions and interruptions decreased significantly between the two-month preimplementation and two-month postimplementation periods: those caused by a physician, NR o r physician assistant; those caused by other personnel; phone calls and pages placed or received by the nurse during medication administration; and conversation unrelated to medication administration that involved the nurse or loud nearby conversation that distracted the nurse. The total number of reported adverse drug events also decreased from 10 to four, or by 60%. Thus, medication safety interventions may help decrease distractions and interruptions in high-acuity settings.

IMPROVING THE CULTURE OF EVIDENCE-BASED PRACTICE AT A MAGNET® HOSPITAL.

ROLE OF THE ACUTE CARE NURSE IN MANAGING PATIENTS WITH HEART FAILURE USING EVIDENCE-BASED CARE.

Paul, Sara; Hice, Amber;

Critical Care Nursing Quarterly, 2014 Oct-Dec; 37 (4): 357-76.

Abstract: Acute heart failure is a major US public health problem, accounting for more than 1 million hospitalizations each year. As part of the health care team, nurses play an important role in the evaluation and management of patients presenting to the emergency department with acute decompensated heart failure. Once acute decompensation is controlled, nurses also play a critical role in preparing patients for hospital discharge and educating patients and caregivers about strategies to improve long-term outcomes and prevent future decompensation and rehospitalization. Nurses’ assessment skills and comprehensive knowledge of acute and chronic heart failure are important to optimize patient care and improve outcomes from initial emergency department presentation through discharge and follow-up. This review presents an overview of current heart failure guidelines, with the goal of providing acute care cardiac nurses with information that will allow them to better use their knowledge of heart failure to facilitate diagnosis, management, and education of patients with acute heart failure.

Abstract: The leading cause of death due to health care-associated infections is ventilator-associated pneumonia (VAP). The lack of clarity in the definition of VAP has made it difficult to execute and evaluate the effectiveness of prevention strategies. Beginning in 2013, hospitals were expected to implement a new surveillance definition algorithm to identify ventilator-associated events (VAEs). The Institute for Healthcare Improvement recommended the use of the Ventilator Care Bundle as part of an initiative to decrease the incidence of VAP. This article outlines the results of a quality improvement project that was conducted to address this recommendation, improve current staff knowledge, identify gaps in practice, and determine the rate of compliance with prevention strategies. The major findings of this project also exposed limitations of the electronic medical record system, and suggested enhancements, which would promote the VAP Bundle initiatives, facilitate documentation, and permit straightforward data collection.

Abstract: Aim To identify, appraise and describe the characteristics of instruments for measuring evidence-based knowledge, skills and/or attitudes in nursing practice. Background Evidence-based practice has been proposed for optimal patient care for more than three decades, yet competence in evidence-based practice knowledge and skills among nurse clinicians remains difficult to measure. There is a need to identify well-validated and reliable instruments for assessing competence for evidence-based practice in nursing. Design Psychometric systematic review. Data Sources The MEDLINE, EMBASE, CINAHL, ERIC, CDSR, All EBM reviews and PsycInfo databases were searched from 1960-April 2013; with no language restrictions applied. Review Methods Using pre-determined inclusion criteria, three reviewers independently identified studies for full-text review, extracting data and grading instrument validity using a Psychometric Grading Framework. Results Of 91 studies identified for full-text review, 59 met the inclusion criteria representing 24 different instruments. The Psychometric Grading Framework determined that only two instruments had adequate validity - the Evidence Based Practice Questionnaire measuring knowledge, skills and attitudes and another un-named instrument measuring only EBP knowledge and attitudes. Instruments used in another nine studies were graded as having weak validity and instruments in the remaining 24 studies were graded as very weak. Conclusion The Evidence Based Practice Questionnaire was assessed as having the highest validity and was the most practical instrument to use. However, the Evidence Based Practice Questionnaire relies totally on self-report rather than direct measurement of competence suggesting a need for a performance-based instrument for measuring evidence-based knowledge, skills and attitudes in nursing.

FOR SEARCHING AND MANAGING EVIDENCE-BASED PRACTICE RESOURCES.

Robb, Meigan; Shellenbarger, Teresa;

Journal of Continuing Education in Nursing, 2014 Oct; 45 (10): 461-6.

Abstract: Evidence-based nursing practice requires the use of effective search strategies to locate relevant resources to guide practice change. Continuing education and staff development professionals can assist nurses to conduct effective literature searches. This article provides suggestions for strategies to aid in identifying search terms. Strategies also are recommended for refining searches by using controlled vocabulary, truncation, Boolean operators, PICOT (Population/Patient Problem, Intervention. Comparison, Outcome, Time) searching, and search limits. Suggestions for methods of managing resources also are identified. Using these approaches will assist in more effective literature searches and may help evidence-based practice decisions.

The RNs at St. Joseph Hospital are curious and inquisitive when it comes to best nursing practice. Our nurses are encouraged to submit their clinical practice questions to our Research Department for review of the best evidence to guide patient care. Here is the first of our series entitled "Clinical Inquiry".
Q: Why do we use sterile water to flush NG tubes? Why cant we use bottled or tap water?
A: Bottled or tap water is only indicated for hydration in healthy patients who are not immunocompromised. Acutely ill patients or those with chronic conditions that have any alterations to the GI tract are vulnerable to nosocomial infections from non-sterile products including water. This also holds true for patients who are immunocompromised but not acutely ill. Because tap water contains metals, medications should only be diluted in sterile water to prevent reduction of bioavailability. Tap water also has the potential to be a source of contamination when reconstituting formula. Filtration of water may be beneficial but still poses a risk for contamination. Sterile water is solute-free and free of chemical or microbial contaminants; therefore, it is the only type of water that should be used to flush NG tubes, dilute medications and reconstitute formula.
response written by Kathleen Pentecost, SRN CBU, BA Sociology & Carla I. Morales, SRN CBU, BS PsychobiologyBankhead, R., Boullata, B.S., Corkins, M., Guenter, P., Krenitsky, J., Lyman, B., et al. (2009) A.S.P.E.N. Enteral nutrition practice recommendations. _Journal of Enteral and Parenteral Nutrition, 33_, 122-69.

Lack of specific guidelines regarding collection of blood for culture from central venous catheters (CVCs) has led to inconsistencies in policies among hospitals. Currently, no specific professional or regulatory recommendations exist in relation to using, reinfusing, or discarding blood drawn from CVCs before drawing blood for a culture. Repeated wasting of blood may harm immunocompromised pediatric oncology patients. The purpose of this comparative study was to determine whether differences exist between blood cultures obtained from the first 5 mL of blood drawn from a CVC line when compared with the second 5 mL drawn.

METHODS:

During 2009-2011, 62 pediatric oncology patients with CVCs and orders for blood cultures to determine potential sepsis were enrolled during ED visits. Trained study nurses aseptically drew blood and injected the normally discarded first 5 mL and the second specimen (usual care) into separate culture bottles. Specimens were processed in the microbiology laboratory per hospital policy.

RESULTS:

Positive cultures were evaluated to assess agreement between specimen results and to determine that the identified pathogen was not a contaminant. Out of 186 blood culture pairs, 4.8% demonstrated positive results. In all positive-positive matches, the normal discard specimen contained the same organism as the usual care specimen. In 4 matches, the normally discarded specimen demonstrated notably earlier time to positivity (4 to 31 hours) compared with the usual care specimen, which resulted in earlier initiation of definitive antibiotics.

DISCUSSION:

These findings support the accuracy of the specimen that is normally discarded and suggest the need to reconsider its use for blood culture testing.

Abstract: In this paper, we introduce the notion of rupture from the French philosopher Michel Foucault, whose studies of discourse and governmentality have become prominent within nursing research during the last 25 years. We argue that a rupture perspective can be helpful for identifying and maintaining a critical potential within nursing research. The paper begins by introducing rupture as an inheritance from the French epistemological tradition. It then describes how rupture appears in Foucaults works, as both an overall philosophical approach and as an analytic tool in his historical studies. Two examples of analytical applications of rupture are elaborated. In the first example, rupture has inspired us to make an effort to seek alternatives to mainstream conceptions of the phenomenon under study. In the second example, inspired by Foucaults work on discontinuity, we construct a framework for historical epochs in nursing history. The paper concludes by discussing the potential of the notion of rupture as a response to the methodological concerns regarding the use of Foucault-inspired discourse analysis within nursing research. We agree with the critique of Cheek that the critical potential of discourse analysis is at risk of being undermined by research that tends to convert the approach into a fixed method.

2. PURSUING A CAREER IN NURSING RESEARCH.

Fawcett, Tonks (Josephine) Nicola; McCulloch, Corrienne;

Nursing Standard, 2014 Mar 12; 28 (28): 54-8.

Abstract: Nursing is an evidence-based profession that uses the latest and best research to improve nursing practice and patient outcomes. Nursing research is needed to generate knowledge and develop nursing care. Despite this, the role of the research nurse is poorly understood and appreciated. This article discusses the importance of the nurses role in clinical research and provides information on how to pursue a career in research.

3. ANALYSIS AND USE OF DIFFERENT RESEARCH REVIEW APPROACHES IN NURSING.

Cope, Diane G.;

Oncology Nursing Forum, 2014 Mar; 41 (2): 207-8.

Abstract: Asignificant increase in nursing research is being conducted as the nursing profession shifts from "ritual" clinical decisions to practice based on research evidence. Evidence-based practice is now an accepted, essential foundation for high-quality patient care. Initially, best practice was based on a few randomized, controlled trials that reflected similar clinical problems. However, with the plethora of nursing research to date, evidence-based nursing practice currently is grounded in summaries of research or research reviews, resulting in robust findings used in the development of clinical guidelines. Several terms exist for reviews, such as literature, integrative, systematic, meta-analysis, and metasynthesis. Similarities can be noted among the types of reviews; however, the objectives and goals of each method differ and the terms should not be used synonymously. This article will define each of the literature and research reviews and discuss methodologic procedures for conducting each method.

Abstract: Background Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. Aim The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. Methods Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. Findings Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. Linking Evidence to Action Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes.

9. ADVANCING ADVANCED PRACTICE — CLARIFYING THE CONCEPTUAL CONFUSION.

Stasa, Helen; Cashin, Andrew; Buckley, Thomas; Donoghue, Judith;

Nurse Education Today, 2014 Mar; 34 (3): 356-61.

Abstract: Summary: Background: In recent years, there has been a substantial increase in the number of nurses holding advanced practice nursing positions. However, the lack of clarity regarding key terms such as ‘advanced practice nursing’, ‘advanced nursing practice’, ‘scope of practice’ and ‘extended practice’, and international variability in how these terms are used has created significant confusion. This lack of clarity is problematic for nurses, other health professionals, health service consumers, educators and policy makers, particularly given the global mobility of the nursing workforce. Objectives: 1) To highlight the significant international variability in how advanced practice nursing, and associated terms such as extended and expanded practice, are defined and regulated across a variety of different English speaking countries, including the US, UK, New Zealand, Canada and Australia. 2) To propose innovative formulations for how the nursing profession may attempt to ensure greater precision and agreement around advanced practice terminology. Design: Discursive paper. Results: It was found that there is a considerable lack of clarity regarding the precise definitions of key terms surrounding the discussion of advanced practice. Additionally, there are large disparities in how the five chosen countries regulate advanced practice nursing, and roles such as that of the nurse practitioner. Conclusions: It is suggested that the confusion regarding advanced practice terminology can be reduced definitionally by minimising the use of the term ‘expanded practice’; defining advanced practice nursing to refer to the type of practice in defined and regulated advanced practice nursing scopes; and defining advanced nursing practice as expert practice within a regulated nursing scope.

10. UNDERSTANDING THE ROLE OF THE PROFESSIONAL PRACTICE ENVIRONMENT ON QUALITY OF CARE IN MAGNET® AND NON-MAGNET HOSPITALS.

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.;

Journal of Nursing Administration, 2014 Jan; 44 (1): 10-6.

Abstract: OBJECTIVE: The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND: Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing fac-tors for these superior outcomes. METHODS: This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environ-ment on quality of care. RESULTS: Nurse-reported quality of care was sig-nificantly associated with Magnet Recognition after matching. The professional practice environment me-diates the relationship between Magnet status and quality of care. CONCLUSION: A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care.

Here are my picks from the nursing literature for February. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.
1. Introducing AORNs New Model for Evidence Rating.SPRUCE, LISA; VAN WICKLIN, SHARON A.; HICKS, RODNEY W.; CONNER, RAMONA; DUNN, DEBRA; AORN Journal, 2014; 99 (2): 243-255.2. Nurses As Knowledge Workers: Is There Evidence of Knowledge in Patient Handoffs?Matney, Susan A.; Maddox, Lory J.; Staggers, Nancy; Western Journal of Nursing Research, 2014 Feb; 36 (2): 171-90. 3. Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit.Cooper, Karen L.; Critical Care Nurse, 2013 Dec; 33 (6): 57-67.Abstract: The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.4. Twitter and nursing research: how diffusion of innovation theory can help uptake.Archibald, Mandy M.; Clark, Alexander M.; Journal of Advanced Nursing, 2014 Mar; 70 (3): e3-5. 5. RESEARCH CORNER. Whats the impact of quality bundles at the bedside?Welchel, Catherine; Berg, Lisa; Brown, Annette; Hurd, Debra; Koepping, Dianne; Stroud, Shalan; Nursing, 2013 Dec; 43 (12): 18-21. Abstract: Background: Managing quality bundles can be challenging for clinical nurses. A study was undertaken to examine quality bundle volumes by patient and nursing perceptions in managing those volumes. Methods: Quantitative and qualitative data were collected from more than 400 patients and their clinical nurses in five hospitals to provide insight into bedside complexities related to quality bundles. Quantitative findings: Patients were assigned up to six bundles; critical care patients had the most bundle assignments. Qualitative findings: Nurses (N = 180) responded to a three-item survey about managing quality bundles. Although 39% of the respondents said they were always aware of the nursing interventions, only 16% responded that they could always complete them. Discussion and conclusions: Strategies to effectively implement quality interventions are critical to nursing workflow and, ultimately, patient care. Workflow assessments, embedded reminders, checklists, and improved data transparency at the bedside are needed to improve quality bundle compliance.6. Evidence-based nursing. Transforming care through leadership and research alignment.Sellars, Bridgett B.; Mayo, Ann; Nursing Management, 2013 Dec; 44 (12): 12-5.7. How DNP and PhD nurses can collaborate to maximize patient care.Moore, Kate; American Nurse Today, 2014 Jan; 9 (1): 48-9. 8. A multimodal approach to EBP.Walter, Monica R.; Aucoin, Julia; Brown, Rosemary; Thompson, Julie A.; Taylor Sullivan, Dori; Nursing Management, 2014 Jan; 45 (1): 14-7. 9. Interventions to minimise the initial use of indwelling urinary catheters in acute care: A systematic review.Murphy, Catherine; Fader, Mandy; Prieto, Jacqui; International Journal of Nursing Studies, 2014; 51 (1): 4-13. Abstract: Background: Indwelling urinary catheters (IUC) are the primary cause of urinary tract infection in acute care. Current research aimed at reducing the use of IUCs in acute care has focused on the prompt removal of catheters already placed. This paper evaluates attempts to minimise the initial placement of IUCs. Objectives: To evaluate systematically the evidence of the effectiveness of interventions to minimise the initial placement of IUCs in adults in acute care. Design: Studies incorporating an intervention to reduce the initial placement of IUCs in an acute care environment in patients aged 18 and over that reported on the incidence of IUC placement were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist has been used as a tool to guide the structure of the review. Data sources: MEDLINE, CINAHL, EMBASE, National Health Service Centre for Review and Dissemination and Cochrane Library. Review methods: A systematic review to identify and synthesise research reporting on the impact on interventions to minimise the use of IUCs in acute care published up to July 2011. Results: 2689 studies were scanned for eligibility. Only eight studies were found that reported any change (increase or decrease) in the level of initial placement of IUCs as a result of an intervention in acute care. Of the eight, six had an uncontrolled before-after design. Seven demonstrated a reduction in the initial use of IUCs post-intervention. There was insufficient evidence to support or rule out the effectiveness of interventions due to the small number of studies, limitations in study design and variation in clinical environments. Notably, each study listed the indications considered to be acceptable uses of an IUC and there was substantial variation between the lists of indications. Conclusions: More work is needed to establish when the initial placement of an IUC is appropriate in order to better understand when IUCs are overused and inform the development of methodologically robust research on the potential of interventions to minimise the initial placement of IUCs.10. Embracing a culture in conducting research requires more than nurses enthusiasm.Loke, Jennifer C.F.; Laurenson, Mary C.; Lee, Kah Wai; Nurse Education Today, 2014 Jan; 34 (1): 132-7. Abstract: Summary: Aims: This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations. Background: Nurses research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated. Methods: A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore. Results: A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived. Conclusions: The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands.

The Value-Based Purchasing Program is forcing hospitals to improve outcomes and decrease costs. This has led to recognition of new care models to improve outcomes and reimbursement. One model is the application of an acute care nurse practitioner (ACNP) into the hospital setting. Model success is dependent on proper implementation to create a synergistic relationship with the organization, ACNP, and patient to improve the quality of care and decrease costs for the hospital.

Happy Holidays! Here are my picks from the nursing literature for December. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.

1. Nurse Educ Today. 2014 Jan;34(1):132-7.

doi: 10.1016/j.nedt.2012.09.006. Epub 2012 Sep 30.

EMBRACING A CULTURE IN CONDUCTING RESEARCH REQUIRES MORE THAN NURSES ENTHUSIASM.

Loke JC, Laurenson MC, Lee KW.

Abstract

AIMS:

This study explored the perceptions of clinical nurses about their research knowledge and experiences to highlight any gaps in nurse education in supporting research activities in healthcare organisations.

BACKGROUND:

Nurses research activities have been encouraged by moving hospital-based nurse education into higher education institutions whereby there is a stronger emphasis on teaching and developing nursing research at both undergraduate and post graduate levels. They were further encouraged by the introduction of advanced nurse practitioner roles, in the hope to increase opportunities for research participation. Whilst nurses research activities have been explored in many countries, nurses in Singapore where there is a strong emphasis on evidence-based practice have not been investigated.

METHODS:

A mixed-methods exploratory descriptive design, using a questionnaire based on open and closed questions was employed to obtain the views of clinical nurses about their capacity and organisational support in conducting research. The questionnaires were distributed to convenient samples who attended one of the 4 research seminars held on separate occasions between July and August 2011 in Singapore.

RESULTS:

A total of 146 nurses were recruited. Whilst nurses demonstrated strong enthusiasm in conducting research, this characteristic feature was not adequate for them to embrace a research culture in organisations. Active participation as co-investigators was not possible in healthcare organisations where skewed distribution of resources towards medical and nurse researchers was perceived.

CONCLUSIONS:

The results suggest a need for a significant shift in focus on educational training from imparting research contents to providing opportunities to experience the research process. Organisational support in terms of protected time and financial support ought to be in place for nursing research experience. The findings also demonstrated that in places where organisational support was available, awareness of research opportunities such as educational and organisational support needed to be strengthened. This in turn would enable more nurses particularly those who provide direct patient care to conduct research within the context of the competing nursing practice demands.

Lean methodology, an evidence-based practice approach adopted from Toyota, is grounded on the pillars of respect for people and continuous improvement. This article describes the use of Lean methodology to improve healthcare outcomes for patients with community-acquired pneumonia. Nurse practitioners and other clinicians should be knowledgeable about this methodology and become leaders in Lean transformation.

3. J Adv Nurs. 2013 Dec;69(12):2622-34.

doi: 10.1111/jan.12152. Epub 2013 Apr 18.

RE-EXAMINING DEFINITIONS OF SPIRITUALITY IN NURSING RESEARCH.

Reinert KG, Koenig HG.

Abstract

AIM:

To discuss the definition of spirituality and its limitations for nursing research. It proposes a definition that will capture more accurately the role of spirituality in health outcomes.

BACKGROUND:

Studies have increasingly examined spirituality in nursing research as a coping mechanism attenuating the negative impact of traumatic stress on mental health. Existing definitions of spirituality in nursing research include elements of positive emotional states (meaning, purpose, general well-being) which confound mental health outcomes.

DATA SOURCES:

Medline and CINAHL databases were searched from 2007-2011 for research articles examining spirituality definitions and measures used by nurse researchers.

DISCUSSION:

An analysis of the definitions of spirituality in nursing research reveals inconsistencies and confounding mental health concepts. The authors propose defining spirituality in the context of religious involvement when conducting research, while using a broader definition of spirituality when providing spiritual care. They argue such definition provides a more appropriate method of measuring this concept in research aimed at evaluating mental health outcomes while preserving the currently used patient-defined definition of spirituality when providing spiritual care.

NURSING IMPLICATIONS:

A consistent definition of spirituality in nursing research evaluating mental health outcomes, distinct from spiritual care in a clinical setting, is essential to avoid tautological results that are meaningless. Appropriate definitions will enable nursing researchers to more clearly identify resilience mechanisms and improved health outcomes in those exposed to traumatic stress.

CONCLUSION:

A definition of spirituality that focuses on religious involvement provides a more uniform and consistent measure for evaluating mental health outcomes in nursing research.

4. Nurse Educ Today. 2013 Dec;33(12):1550-6.

doi: 10.1016/j.nedt.2013.01.005. Epub 2013 Feb 8.

ENHANCING COMMUNICATION WITH DISTRESSED PATIENTS, FAMILIES AND COLLEAGUES: THE VALUE OF THE SIMPLE SKILLS SECRETS MODEL OF COMMUNICATION FOR THE NURSING AND HEALTHCARE WORKFORCE.

Good communication skills in healthcare professionals are acknowledged as a core competency. The consequences of poor communication are well-recognised with far reaching costs including; reduced treatment compliance, higher psychological morbidity, incorrect or delayed diagnoses, and increased complaints. The Simple Skills Secrets is a visual, easily memorised, model of communication for healthcare staff to respond to the distress or unanswerable questions of patients, families and colleagues.

OBJECTIVES:

To explore the impact of the Simple Skills Secrets model of communication training on the general healthcare workforce.

DESIGN AND METHODS:

An evaluation methodology encompassing a quantitative pre- and post-course testing of confidence and willingness to have conversations with distressed patients, carers and colleagues and qualitative semi-structured telephone interviews with participants 6-8 weeks post course.

PARTICIPANTS:

During the evaluation, 153 staff undertook the training of which 149 completed the pre- and post-training questionnaire. A purposive sampling approach was adopted for the follow up qualitative interviews and 14 agreed to participate.

This model can be suggested as increasing the confidence of staff, in dealing with a myriad of situations which, if handled appropriately can lead to increased patient and carers satisfaction. Empowering staff appears to have increased their willingness to undertake these conversations, which could lead to earlier intervention and minimise distress.

5. Appl Nurs Res. 2013 Nov;26(4):263-8.

doi: 10.1016/j.apnr.2013.05.004. Epub 2013 Aug 6.

WHY ISNT EVIDENCE BASED PRACTICE IMPROVING HEALTH CARE FOR MINORITIES IN THE UNITED STATES?

Lee H, Fitzpatrick JJ, Baik SY.

Abstract

Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence. The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.

IMPAD-22: A CHECKLIST FOR AUTHORS OF QUALITATIVE NURSING RESEARCH MANUSCRIPTS.

Salzmann-Erikson M.

Abstract

OBJECTIVE:

The aim of this paper is to develop a checklist for authors preparing qualitative nursing research manuscripts, specifically focusing on the method section.

DESIGN:

Literature review.

DATA SOURCES:

15 articles were purposefully selected from three different nursing journals.

REVIEW METHODS:

Evans four step process was used to synthesize the method sections of the included articles.

RESULTS:

Four main categories were identified 1) Ingress and Methodology, 2) Participants, 3) Approval, and 4) Data: Collection and Management. Based on the categories and sub-categories, a 22-item checklist was developed.

DISCUSSION AND CONCLUSIONS:

Earlier guidelines for formal reporting were developed for qualitative research in general. The main advantage and contribution of IMPAD is that it provides a 22-item checklist specifically aimed towards the method section, and furthermore, it was developed specifically for authors within the field of nursing research.

8. Clin J Oncol Nurs. 2013 Oct;17(5):544-9.

doi: 10.1188/13.CJON.544-549.

THE EXPERIENCE OF IMPLEMENTING EVIDENCE-BASED PRACTICE CHANGE: A QUALITATIVE ANALYSIS.

Irwin MM, Bergman RM, Richards R.

Abstract

The Oncology Nursing Society (ONS) and ONS Foundation worked together to develop the Institute for Evidence-Based Practice Change (IEBPC) program to facilitate the implementation of evidence-based practice (EBP) change in nursing. This analysis describes the experience of 19 teams of nurses from various healthcare settings who participated in the IEBPC program. Qualitative analysis of verbatim narratives of activities and observations during the process of implementing an EBP project was used to identify key themes in the experience. EBP implementation enabled participants to learn about their own practice and to experience empowerment through the evidence, and it ignited the spirit of inquiry, team work, and multidisciplinary collaboration. Experiences and lessons learned from nurses implementing EBP can be useful to others in planning EBP implementation.

9. Intensive Crit Care Nurs. 2013 Oct;29(5):256-60.

doi: 10.1016/j.iccn.2013.03.004. Epub 2013 May 11.

APN-LED NURSING ROUNDS: AN EMPHASIS ON EVIDENCE-BASED NURSING CARE.

Mahanes D, Quatrara BD, Shaw KD.

Abstract In todays healthcare environment, nursing staff are challenged to care for patients with increasingly complex needs in an ever-changing environment. Nurses are expected to stay up to date on a tremendous number of institutional initiatives, best practice guidelines, and policies and procedures. These practice imperatives are often disseminated through passive means of information-sharing such as staff meetings and electronic mail. In this setting, it is difficult for nurses to simultaneously focus on incorporating practice updates while continuing to value basic nursing functions such as oral care, skin care, and incontinence management. The concept of Interventional Patient Hygiene emphasises that basic nursing functions are not only tasks, but also important evidence-based interventions that contribute to improved health for the patient. Interventional Patient Hygiene facilitates the integration of science and practice. This article describes a quality improvement intervention, Advanced practice nurse-led nursing rounds, which supports Interventional Patient Hygiene and be used to help staff integrate best practices while balancing the multiple priorities inherent in nursing care.

10. J Contin Educ Nurs. 2013 Oct;44(10):447-54.

doi: 10.3928/00220124-20130801-45. Epub 2013 Aug 8.

A HOSPITAL NURSING RESEARCH ENHANCEMENT MODEL.

Edward KL, Mills C.

Abstract

Evidence-based practice is fundamental to nursing, yet there are many reports in the literature of the difficulty associated with incorporating research activity that leads to evidence-based practice into daily practice. This study used a hospital-based research enhancement model (HREM) to plan, develop, and implement a research outreach ward-based seminar (ROWS) program and evaluate its effectiveness as a means for nurses to increase their knowledge and capacity in research and evidence-based practice. A survey was used to collect both quantitative and qualitative data for evaluation of the program. A total of 78 evaluations were returned after ROWS attendance. Three main themes from the survey were explored. These include accessibility of research, appreciation and application of research, and training in research. The results suggested that nurses are interested in participating in research activities, including projects, best practice forums, journal clubs, and seminars. The HREM can address some common barriers to an evidence-based practice culture and the application of evidence-based practice within nursing.

11. J Nurs Adm. 2013 Oct;43(10):509-16.

doi: 10.1097/NNA.0b013e3182a3e7ff.

USING A SHARED GOVERNANCE STRUCTURE TO EVALUATE THE IMPLEMENTATION OF A NEW MODEL OF CARE: THE SHARED EXPERIENCE OF A PERFORMANCE IMPROVEMENT COMMITTEE.

Sustaining change in the behaviors and habits of experienced practicing nurses can be frustrating and daunting, even when changes are based on evidence. Partnering with an active shared governance structure to communicate change and elicit feedback is an established method to foster partnership, equity, accountability, and ownership. Few recent exemplars in the literature link shared governance, change management, and evidence-based practice to transitions in care models. This article describes an innovative staff-driven approach used by nurses in a shared governance performance improvement committee to use evidence-based practice in determining the best methods to evaluate the implementation of a new model of care.

12. J Nurs Adm. 2013 Oct;43(10 Suppl):S42-50.

doi: 10.1097/01.NNA.0000435150.13788.34.

CREATIVE APPROACHES TO INCREASING HOSPITAL-BASED NURSING RESEARCH.

Wilson B, Kelly L, Reifsnider E, Pipe T, Brumfield V.

13. J Nurs Adm. 2013 Oct;43(10 Suppl):S28-35.

doi: 10.1097/01.NNA.0000435148.24090.ea.

NATIONAL SURVEY OF HOSPITAL NURSING RESEARCH, PART 1. RESEARCH REQUIREMENTS AND OUTCOMES.

EXPLORING FACTORS ASSOCIATED WITH NURSES ADOPTION OF AN EVIDENCE-BASED PRACTICE TO REDUCE DURATION OF CATHETERIZATION.

Conner BT, Kelechi TJ, Nemeth LS, Mueller M, Edlund BJ, Krein SL.

Abstract Hospitalized adult patients are at increased risk for adverse outcomes, particularly when undergoing invasive procedures that include indwelling urinary catheterization. This study identified factors associated with nurses adoption of an evidence-based practice to reduce the duration of catheterization and potential for catheter-associated urinary tract infections in hospitalized adults.

Congratulations to Beth Winokur, PhD, RN, Jeannine Loucks, MSN, RN and their colleagues from St. Jude and Mission Hospitals for publishing their findings on a behavioral health competency tool for RNs working on non-behavioral health units.
Journal for Nurses in Professional Development.
2013 Sep-Oct;29(5):255-62. doi: 10.1097/01.NND.0000433150.18384.1c. HOSPITAL STAFF NURSE PERCEPTIONS OF COMPETENCY TO CARE FOR PATIENTS WITH PSYCHIATRIC OR BEHAVIORAL HEALTH CONCERNS.
Rutledge DN, Wickman ME, Cacciata M, Winokur EJ, Loucks J, Drake D.
Abstract Disruptive behaviors are common among hospitalized patients with psychiatric and substance abuse behaviors. Nurses working on nonpsychiatric units, however, may lack competencies to care for patients with such behaviors. A survey was developed and administered to 844 nurses across three hospital settings that revealed a lack of nurse confidence to intervene in situations that require de-escalation techniques and crisis communication. This study provides direction for further research and interventions in hospital settings with similar professional development needs.
This is the second article Dr. Winokur and her colleagues have published on their behavioral health competency tool. St. Joseph Hospital staff have access to the full article by contacting the Burlew Medical Library.

My it has been a while! Here are my picks of the nursing literature for October. SJO and CHOC staff have access to the articles by contacting Burlew Medical Library.
1. APN-LED NURSING ROUNDS: AN EMPHASIS ON EVIDENCE-BASED NURSING CARE.Mahanes, Dea; Quatrara, Beth D.; Shaw, Katherine Dale; Intensive & Critical Care Nursing, 2013; 29 (5): 256-60. Abstract: In todays healthcare environment, nursing staff are challenged to care for patients with increasingly complex needs in an ever-changing environment. Nurses are expected to stay up to date on a tremendous number of institutional initiatives, best practice guidelines, and policies and procedures. These practice imperatives are often disseminated through passive means of information-sharing such as staff meetings and electronic mail. In this setting, it is difficult for nurses to simultaneously focus on incorporating practice updates while continuing to value basic nursing functions such as oral care, skin care, and incontinence management. The concept of Interventional Patient Hygiene emphasises that basic nursing functions are not only tasks, but also important evidence-based interventions that contribute to improved health for the patient. Interventional Patient Hygiene facilitates the integration of science and practice. This article describes a quality improvement intervention, Advanced practice nurse-led nursing rounds, which supports Interventional Patient Hygiene and be used to help staff integrate best practices while balancing the multiple priorities inherent in nursing care.2. DEVELOPING COMPLEX INTERVENTIONS FOR NURSING: A CRITICAL REVIEW OF KEY GUIDELINES.Corry, Margarita; Clarke, Mike; While, Alison E; Lalor, Joan; Journal of Clinical Nursing, 2013 Sep; 22 (17/18): 2366-86. Abstract: Aims and objectives To identify the most comprehensive approach to developing complex interventions for nursing research and practice. Background The majority of research in nursing is descriptive and exploratory in nature. There is an increasing professional and political demand for nurses to develop and provide evidence to support their practices. Nurses need to explore current practice and develop and test interventions to provide the evidence required for safe practice. Design A literature review using a systematic approach. Methods The review was carried out using four databases: CINAHL, Pub Med, Psyc INFO and BNI (2000-2011), and the search was limited to brief interventions and complex intervention development ( January 2000- September 2011). Included papers reported on guidelines for intervention development or how an intervention was developed. Results Six papers reported on guidelines for developing interventions. There are many similarities between the guidelines with a similar pattern of guideline development in Europe and the USA. The only guideline reported to have been used in the development of interventions is the Medical Research Council framework ( MRC) (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000), with 9 of 14 papers that describe the development of an intervention reporting the use of this guideline. The other five papers did not mention the use of any guideline or framework. Conclusions The MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework appears to be the most widely used guideline reported for developing complex interventions. Although the updated MRC (Developing and Evaluating Complex Interventions, 2008) framework adds considerably to the original MRC (A Framework for Developing and Evaluation of RCTs for Complex Interventions to Improve Health, 2000) framework, other guidelines contribute additional guidance which can inform the development of nursing interventions. These additional guidelines are presented in a model for developing complex interventions for nursing. Relevance to clinical practice The model will help nurses planning to develop nursing interventions as it provides additional and nursing-specific guidance to the MRC (Developing and Evaluating Complex Interventions, 2008) framework for the development of complex interventions for nursing practice.3. CITATION CLASSICS IN NURSING JOURNALS: THE TOP 50 MOST FREQUENTLY CITED ARTICLES FROM 1956 TO 2011.Y. Wong, Eliza L.; S. Tam, Wilson W.; Y. Wong, Faye C.; L. Cheung, Annie W.; Nursing Research, 2013 Sep-Oct; 62 (5): 344-51. Abstract: Background: Assessing the impact of individual journal articles provides information for understanding trends in science and translation of findings on practice. Citation analysis is an important way to highlight the contributions of individual author/ investigator and journals on nursing practice. Objective: The purpose of this study was to identify the most frequently cited articles published in nursing journals from 1956 to 2011. Methods: The Science Citation Index Expanded and Social Sciences Citation Index were searched for citations through 2011 to articles published in the 89 nursing journals listed on the Journal Citation Reports (2010 edition). The number of citations, topic, countries, and institutions of origin based on the first author affiliation, year of publication, study design, publishing journal, journal country, and journal impact factor were noted. The most frequently cited articles published in the 89 nursing journals from 1956 to 2011 were identified. Results: The top 50 most frequently cited articles were published in 10 nursing journals between 1970 and 2005. The top cited article received 784 citations. The most common topics were methodology for qualitative studies, validation procedures for tool development, and nursing care and practices in cancer and mental health. The most common study designs were reviews Including meta-analysis and instrument validation. Most of the top 50 cited articles were published from 1986 to 1995. Discussion: The findings provide insights into priorities and trends in nursing research and translational science.4. DEFINING WHAT EVIDENCE IS, LINKING IT TO PATIENT OUTCOMES, AND MAKING IT RELEVANT TO PRACTICE: INSIGHT FROM CLINICAL NURSES.Jeffs, Lianne; Beswick, Susan; Lo, Joyce; Campbell, Heather; Ferris, Ella; Sidani, Souraya; Applied Nursing Research, 2013 Aug; 26 (3): 105-9. Abstract: Background/Rationale: Factors that impede or enable successful evidence based practice for nurses in their daily work is well documented. Less known is how nurses define evidence in their daily clinical practice and how this knowledge can inform strategies to enhance evidence based patient care and outcomes. Aims/Methods: A qualitative study was undertaken to explore nurses perceptions of what constitutes evidence as part of EBP and how applicable evidence is to their daily practice. A qualitative design using semi-structured interviews was employed for this study. Data were analyzed using directed content analysis. Results: The following four key themes emerged: viewing evidence as research based and a proven practice; linking evidence to patient outcomes; basing evidence on experience; and making evidence relevant to practice. Implications: Study findings point to having accessible, practical tools to make evidence credible and relevant for nurses tailored to their clinical contexts.5. SCHOLARLY PUBLICATION PRACTICES OF DOCTOR OF NURSING PRACTICE-PREPARED NURSES.Broome, Marion E.; Riner, Mary E.; Allam, Eman S.; Journal of Nursing Education, 2013 Aug; 52 (8): 429-10. Abstract: Doctor of Nursing Practice (DNP) graduates are expected to contribute to nursing knowledge through empirically based studies testing the effectiveness of practice approaches that ultimately benefit patients and health care systems. This article describes publication practices of DNP graduates in the scholarly literature. Published studies (2005 to 2012) with at least one author with a DNP degree were identified. The search yielded 300 articles in 59 journals; 175 met the inclusion criteria and were included in this study. A codebook, consisting of 15 major categories, was used to extract relevant information. Original clinical investigations were the most frequent, followed by practice-focused patient and provider studies. The number of studies published in peer-reviewed journals with DNP-prepared authors increased over time. We recommend greater integration of translational science models into DNP curricula to achieve the goal of publishing scholarly products that use evidence to improve either practice or patient outcomes.6. TURNING KNOWLEDGE INTO ACTION AT THE POINT-OF-CARE: THE COLLECTIVE EXPERIENCE OF NURSES FACILITATING THE IMPLEMENTATION OF EVIDENCE-BASED PRACTICE.Dogherty, Elizabeth J.; Harrison, Margaret B.; Graham, Ian D.; Vandyk, Amanda Digel; Keeping-Burke, Lisa; Worldviews on Evidence-Based Nursing, 2013; 10 (3): 3rd Quarter: 129-39. Abstract: ABSTRACT Background Facilitation is considered a way of enabling clinicians to implement evidence into practice by problem solving and providing support. Practice development is a well-established movement in the United Kingdom that incorporates the use of facilitators, but in Canada, the role is more obtuse. Few investigations have observed the process of facilitation as described by individuals experienced in guideline implementation in North America. Aim To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. Methods Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. Results A number of factors emerged at various levels associated with the successes and failures of participants efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. Conclusions Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. With a greater understanding of factors contributing to successful or unsuccessful facilitation, future research should focus on analyzing facilitation interventions tailored to address barriers and enhance facilitators of evidence uptake.7. THE FINANCIAL AND CLINICAL BENEFITS OF A HOSPITAL-BASED PHD NURSE RESEARCHER.Staffileno, Beth A.; Wideman, Marilyn; Carlson, Elizabeth; Nursing Economic$, 2013 Jul-Aug; 31 (4): 194-7.8. USE, KNOWLEDGE, AND ATTITUDES TOWARD EVIDENCE-BASED PRACTICE AMONG NURSING STAFF.White-Williams, Connie; Patrician, Patricia; Fazeii, Pariya; Degges, Mary Ann; Graham, Shannon; Andison, Margot; Shedlarski, Antoinette; Harris, Lindsey; McCaleb, K. Alberta; Journal of Continuing Education in Nursing, 2013 Jun; 44 (6): 246-54. Abstract: Background: Little information is known about the use, knowledge, and attitudes toward evidence-based practice (EBP) among nurses in a large academic hospital. This cross-sectional, descriptive study examined the knowledge, attitudes, and use of EBP by nurses at a large academic, Magnet®-designated medical center. Methods: Data were collected from 593 nurses who completed the Clinical Effectiveness and Evidence Based Practice Questionnaire between November 2011 and March 2012. Statistical analyses included correlations and multivariate analysis of covariance. Results: Most nurses (96%) reported that they were aware that an EBP and Research Council existed. The average scores were highest on the Attitudes subscale, followed by the Knowledge/Skills and Practice subscales. Conclusion: Continuing education for nurses makes a difference in nurses attitudes, knowledge, and use of EBP in practice. Participation in EBP and research educational activities or Council meetings may affect EBP culture in a large academic medical center.9. THE EVOLVING ROLE AND VALUE OF LIBRARIES AND LIBRARIANS IN HEALTH CARE.Sollenberger, Julia F; Holloway Jr, Robert G; JAMA: Journal of the American Medical Association, 2013 Sep 25; 310 (12): 1231-2.10. THE EFFECT OF A CLINICAL MEDICAL LIBRARIAN ON IN-PATIENT CARE OUTCOMES.Esparza, Julia M.; Shi, Runhua; McLarty, Jerry; Comegys, Marianne; Banks, Daniel E.;Journal of the Medical Library Association, 2013 Jul; 101 (3): 185-91. Abstract: Objective: The research sought to determine the effect of a clinical medical librarian (CML) on outcomes of in-patients on the internal medicine service. Methods: A prospective study was performed with two internal medicine in-patient teams. Team 1 included a CML who accompanied the team on daily rounds. The CML answered questions posed at the point of care immediately or in emails post-rounds. Patients on Team 2, which did not include a CML, as well as patients who did not require consultation by the CML on Team 1, served as the control population. Numerous clinical and library metrics were gathered on each question. Results: Patients on Team 1 who required an answer to a clinical question were more ill and had a longer length of stay, higher costs, and higher readmission rates compared to those in the control group. Using a matched pair analysis, we showed no difference in clinical outcomes between the intervention group and the control group. Conclusions: This study is the largest attempt to prospectively measure changes in patient outcomes when physicians were accompanied by a CML on rounds. This approach may serve as a model for further studies to define when and how CMLs are most effective.11. CLINICAL INQUIRY. MONITORING THE QUALITY OF CLINICAL INQUIRY PROJECTS.Bolte, Jean; Granger, Bradi B.; AACN Advanced Critical Care, 2013 Jan-Mar; 24 (1): 78-81. Abstract: The article discusses the importance of educating nurses about the components of monitoring for clinical inquiry and states ways of educating them one of which is to involve them in monitoring activities. It also states that monitoring is important for local quality improvement or unit-based studies and establishing a quality monitoring plan is essential for good clinical practice. It also discusses the components, timing and frequency of monitoring the projects.